Chapter 14: Peritoneum Wall

Which of the following structures are considered parts of the peritoneal cavity?

E. All of the above (lesser and greater omentum, mesenteries, ligaments, multiple fluid spaces)

Which layer of the peritoneum lines the walls of the peritoneal cavity?

Parietal peritoneum

The general peritoneal cavity is also known as the:

Greater sac

Which best describes the greater omentum?

An apron-like fold of peritoneum that hangs from the greater curvature of the stomach and can adhere to diseased organs

The epiploic foramen (Foramen of Winslow) communicates between:

Greater sac and Lesser sac (omental bursa)

Which peritoneal space is most commonly referred to as Morison’s pouch?

Right subhepatic space

When supine, where does fluid accumulate most often?

Pelvis and paracolic gutters

The falciform ligament divides which peritoneal space?

Subphrenic space (into right and left components)

Which ligament connects the gastric greater curvature to the splenic hilum?

Gastrosplenic ligament

Which space is the pouch of Douglas in females?

Posterior rectouterine sac

Which structure extends from the liver to the lesser curvature of the stomach?

Lesser omentum

Which statement about the greater omentum is true?

It prevents spread of infection by adhering to diseased organs

Which peritoneal space is between the right lobe of the liver and diaphragm?

Right subphrenic space

Which ligament ascends from the umbilicus to the umbilical notch of the liver?

Ligamentum teres hepatis

Retroperitoneal masses displace which structures anteriorly?

Superior mesenteric vessels, splenic vein, renal vein, IVC

Which space is also called the hepatogastric recess?

Left subhepatic space

The bare area of the liver is delineated by:

Right superior and inferior coronary ligaments

Which abdominal wall structure forms the vertical groove at rectus border?

Linea semilunaris (Spigelian fascia)

In females, which recess lies between bladder and uterus?

Vesicouterine recess

On ultrasound, the peritoneal line appears as:

A discrete linear echogenicity in the deepest abdominal wall

Which intraperitoneal compartment surrounds the caudate lobe?

Lesser sac (omental bursa)

The rectus abdominis muscles are delineated medially by:

Linea alba

What are the two layers of the peritoneum?

Parietal peritoneum (lines walls) and Visceral peritoneum (covers organs)

What is a mesentery?

A double fold of peritoneum that suspends small intestine, transverse colon, and sigmoid colon

What does 'retroperitoneal' mean?

Organs located behind the peritoneum, e.g., kidneys, ascending and descending colon

What is the lesser sac also called?

Omental bursa

Where is the epiploic foramen located?

Inferior to the liver, superior to the first part of duodenum; IVC posterior, portal vein anterior

Which space is most commonly evaluated for fluid in trauma?

Morison’s pouch (right subhepatic space)

Why is the peritoneal cavity important for sonographers?

Fluid accumulates in dependent areas like pelvis and paracolic gutters, must be checked for pathology

Which ligament divides the subphrenic space?

Falciform ligament

What structure forms the posterior border of the lesser sac?

Splenorenal ligament

What does the greater omentum contain that helps fight infection?

Epiploic branches of gastroepiploic vessels bringing phagocytes

Which space is divided into anterior vesicouterine and posterior rectouterine (pouch of Douglas)?

Retrovesical space in females

What is the male equivalent of the pouch of Douglas?

Rectovesical pouch

What structures form the paravesical spaces?

Peritoneum with bladder, obliterated umbilical arteries, inferior epigastric vessels

What is seen as a 'dumbbell' shape compressing bladder?

Fluid in extraperitoneal paravesical space

What displaces bladder inferiorly but not posteriorly?

Intraperitoneal ascites

Which abdominal wall layers are identified on ultrasound?

Skin (echogenic), fat (hypoechoic), muscle (hyperechoic to fat), peritoneal line (echogenic)

What are the layers of the abdominal wall from superficial to deep?

Skin, superficial fascia, subcutaneous fat, muscles, transversalis fascia, peritoneum

What are the anterolateral abdominal wall muscles?

External oblique, internal oblique, transversus abdominis, rectus abdominis

What is an aponeurosis?

Flat sheet-like fibrous tissue replacing a tendon in flat muscles; forms linea semilunaris

Which clinical indications may require peritoneal/abdominal wall exam?

Fever, pain, palpable mass, bleeding, trauma, post-surgery, distended abdomen, dyspnea

What are the two main perihepatic potential spaces?

Right subhepatic space (Morison’s pouch) and Left subhepatic space (hepatogastric recess)

How do hepatic/subhepatic lesions differ from retroperitoneal lesions in displacement?

Retroperitoneal lesions displace echoes ventrally and cranially, while hepatic/subhepatic lesions displace structures inferiorly and posteriorly

What is an aponeurosis?

A sheet of white fibrous tissue replacing a tendon in flat muscles, uniting abdominal wall muscle layers and forming the linea semilunaris

What is the sonographic appearance of skin, fat, and muscle in the abdominal wall?

Skin: thin, echogenic; Fat: variable, usually hypoechoic to skin and muscle; Muscle: hyperechoic to subcutaneous fat

What are the two main perihepatic potential spaces?

Right subhepatic space (Morison’s pouch) and Left subhepatic space (hepatogastric recess)

How do hepatic/subhepatic lesions differ from retroperitoneal lesions in displacement?

Retroperitoneal lesions displace echoes ventrally and cranially, while hepatic/subhepatic lesions displace structures inferiorly and posteriorly

What is an aponeurosis?

A sheet of white fibrous tissue replacing a tendon in flat muscles, uniting abdominal wall muscle layers and forming the linea semilunaris

What is the sonographic appearance of skin, fat, and muscle in the abdominal wall?

Skin: thin, echogenic; Fat: variable, usually hypoechoic to skin and muscle; Muscle: hyperechoic to subcutaneous fat